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Bluecross Blueshield Of South Carolina Jobs & Careers

76 Jobs Found

BlueCross BlueShield of South Carolina
There are three positions available. Work hours are 8 a.m. - 5 p.m., Monday through Friday Supervises staff responsible for medical records review ensuring that documentation supports that Medicare home health benefit requirements are met. Required ......
BlueCross BlueShield of South Carolina
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies and established clinical criteria to service requests, or provides health management program int......
BlueCross BlueShield of South Carolina
Performs independent, objective information systems (IS) audits and consulting services. Supplies management at all levels with objective evaluations, appraisals and recommendations concerning the areas reviewed. Required Education Bachelor's degree......
BlueCross BlueShield of South Carolina
Provides education to medical providers as warranted. Work hours are Monday through Friday from 8:30 a.m. to 5 p.m . Required Education If LPN, graduate of an accredited school of Licensed Practical Nursing; if LVN, graduate of an accredited scho......
BlueCross BlueShield of South Carolina
The main purpose of a quality management system (QMS) auditor is to perform ISO 9001 internal QMS audits for all areas at a BlueCross subsidiary that are certified or seeking certification, as compliant to the ISO 9001 QMS standard. Required Educati......
BlueCross BlueShield of South Carolina
Focus on enterprise-wide data modeling and database design. Define data architecture standards, policies and procedures for the organization, structure, attributes and nomenclature of data elements. This is a Public Trust position and requires havin......
BlueCross BlueShield of South Carolina
Responsible for supporting the business development and maintenance of a department's website. Analyzes web business needs and the subsequent development of strategies to meet those needs. Required Education Bachelor's degree or four years of job......
BlueCross BlueShield of South Carolina
Responsible for conducting and assisting in documenting moderate to complex financial analysis projects following standard practices and procedures. Participates in studies to improve the operational and financial effectiveness of the unit. Extracts......
BlueCross BlueShield of South Carolina
Responsible for the supervision and maintenance of the daily functions of utilization review/review nurses, case management and/or medical review staff and specialty programs. Ensures appropriate levels of health care services are provided. Required......
BlueCross BlueShield of South Carolina
Manages the design and implementation of defined infrastructure solutions through the use of project methodologies for internal and external customers, leveraging existing standardized service offerings or creating new services based on platform and......
BlueCross BlueShield of South Carolina
There are multiple positions available. Work hours are 8 a.m. to 5 p.m., Monday through Friday Supervises staff responsible for medical records review, ensuring documentation supports that Medicare home health benefit requirements are met. Required ......
BlueCross BlueShield of South Carolina
There are multiple work-at-home opportunities for qualified RNs available to report to work by August 29, 2016. Researches the substance of complex Medicare home health appeal or retrospective review requests. Provides thorough clinical reviews or b......
BlueCross BlueShield of South Carolina
Analyzes and develops complex logical and physical database designs, data models and relational data definitions in support of corporate and client information systems requirements. Administration of activities for application databases, platforms, ......
BlueCross BlueShield of South Carolina
Responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management and/or Appeals, to include departmental s......
BlueCross BlueShield of South Carolina
Two positions are available and will be located on site in Columbia, SC. Acts as the team lead for specialty programs, medical review, utilization management and case management areas by providing assistance and support to unit supervisor or manager......
BlueCross BlueShield of South Carolina
There are multiple work-at-home opportunities for qualified LPNs available to report to work by August 22, 2016. Performs medical reviews using established criteria sets to determine if documentation submitted supports that Medicare home health bene......
BlueCross BlueShield of South Carolina
Responsible for the supervision and maintenance of the daily functions of the following areas: utilization review/review nurses, case management, medical review, health/disease management, quality management and appeals, to include departmental staf......
BlueCross BlueShield of South Carolina
Provides expertise regarding architectural principles across one or more lines of business. Provides consultative services to high-level clients, ensuring technical risks and opportunities are considered and appropriately addressed in business initi......
BlueCross BlueShield of South Carolina
There are multiple work-at-home opportunities for qualified RNs available to report to work by August 22, 2016. Performs medical reviews using established criteria sets to determine if documentation submitted supports that Medicare home health benef......
BlueCross BlueShield of South Carolina
Researches the substance of complex appeal or retrospective review requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions within mandated timefram......
BlueCross BlueShield of South Carolina
This position is located on-site in Columbia, SC. Assists with implementation of health management activities and programs for BlueCross BlueShield of South Carolina and/or BlueChoice HealthPlan members. Required Education Bachelor's degree in Nu......
BlueCross BlueShield of South Carolina
This position is located on site in Columbia, SC. Monitors and implements quality improvement and management activities. Conducts specific medical reviews as necessary, analyzes findings, makes recommendations for corrective actions and prepares for......
BlueCross BlueShield of South Carolina
Responsible for the maintenance of records and the processing of claims in medical review. Processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claim......
BlueCross BlueShield of South Carolina
There are multiple positions available with the potential to work from home after 8-12 weeks of training in Columbia, SC. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or o......
BlueCross BlueShield of South Carolina
Develops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical data findings. Assists with sophisticated data interpretation, compilation and verification ......
BlueCross BlueShield of South Carolina
This position is located on site in Salt Lake City, Utah . Provides overall administrative support to sales and marketing areas. Prepares proposals on new sales and renewals. Required Education High school diploma or equivalent. Required Work Exp......
BlueCross BlueShield of South Carolina
Responsible for the successful marketing (sales, renewals and/or service) of group and/or individual accounts for products as defined by production quotas within assigned territory. Required Education High school diploma or equivalent. Preferred: Ba......
BlueCross BlueShield of South Carolina
Develops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical data findings. Assists with sophisticated data interpretation, compilation and verification ......
BlueCross BlueShield of South Carolina
Responsible for entry-level accounting activities relating to the maintenance of a complete and accurate general ledger, the resultant managerial reports and/or financial statements. Required Education Bachelor's degree in Accounting or a related......
BlueCross BlueShield of South Carolina
Provides strategic planning/oversight/decision-making/direction of clinical and business aspects of all lines of medical case management business. Oversees and directs the development, evaluation and implementation of new or changing health case man......
BlueCross BlueShield of South Carolina
Four positions available on-site in Columbia, SC. Work hours are 8:30 a.m. to 5 p.m. Monday through Friday. Coordinates the quality control program for the medical review area. Researches the Center for Medicare & Medicaid Services (CMS) changes. Tr......
BlueCross BlueShield of South Carolina
There are multiple positions available with the potential to work from home after 6-12 weeks of training in Columbia, SC. Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or o......
BlueCross BlueShield of South Carolina
Identify and resolve information flow, content issues and the transformation of business requirements into logical data models. Analyze and develop logical or physical database designs, data models and relational data definitions in support of corpo......
BlueCross BlueShield of South Carolina
There are multiple work-at-home opportunities for qualified RNs available to report to work by August 22, 2016. Performs medical reviews using established criteria sets to determine if documentation submitted supports that Medicare home health benef......
BlueCross BlueShield of South Carolina
There are multiple work-at-home opportunities for qualified RNs available to report to work by August 29, 2016. Researches the substance of complex Medicare home health appeal or retrospective review requests. Provides thorough clinical reviews or b......